airborne infectious disease transmitted by inhaling TB bacteria put into the air by a person with active TB. Overcrowding and poor ventilation and poor sanitation facilitates disease spread

Term

Latent TB

Definition

no symptoms, not infectious, small risk of developing active TB and the transition is very dependent of the strength of the immune system. Malnutrition, HIV/AIDS and other co-morbidities encourage it.

Term

Active TB

Definition

Symptomatic and infectious. Each active TB patient will infect 10-15 people per year and if it is not treated there is a 2/3 mortality rate. Treatment takes 6-8 months

Term

Global Burden of TB

Definition

It is the leading infectious cause of adult mortality in the world, with up to 1/3 of the global population infected (half of which will not be diagnosed. 6% growth rate in new infections annually -- disease is spreading

most cases occur in the developing world as do most of the deaths

disease and death hits 14-54 year olds (very broad range)

TB kills more women than all other of the maternal deaths combined

costs 12 billion dollars a year

Term

4 causes for TB resurgence

Definition

HIV/AIDS

Multi drug resistant strains of TB

Lapse of TB control programs

Structural factors (especially poverty)

Term

TB and HIV/AIDS

Definition

HIV/AIDS leads to more vulnerability: 1/3 of people globally with HIV/AIDS are infected with TB and in Sub-Saharan Africa, up to 70% of HIV/AIDS patients have TB

TB accelerates the replication of HIV and leads to the replication of HIV and the onset of AIDS : it is a major cause of death for HIV/AIDS patients

HIV positive patients need to be tested and treated for TB

Term

TB and Poverty

Poverty causes and is therefore linked to TB:

(9)

Definition

Malnutrition

overcrowding

poor sanitation

inadequate health care

low education

unstable housing

unstable employment

social marginalization

co-morbidity with other disease

Term

Prevention and Treatment

Definition

Vaccination for children

Treatment is done by taking two or three different types of antibiotics

standardized treatments lasting 6-8 months for those testing postive on the sputum smear. They must be directly observed for the first two months

regular and unterupted supply of the anti-TB drugs

standardizing and reporting system that allows for assement and outreach for the patient and the TB control program

Term

DOTS results in China

Definition

TB is the leading cause of adult mortality in China from infectious disease but when a DOTS program was implemented (with monetary benifits given to doctors who ensured the proper implementation of DOTS) there was a decline of almost 40% of TB prevelance in DOTS areas compared to non-DOTS areas which only experienced a 3 % decrease. In addtion, there was strong government support and the treatment was provided for free. There was an extensive support network implemented through local doctors and village networks and infrastructure was provided in the form of clinics, training staff and local and national recording of cases.

Term

Challenges of TB treatment in India and DOTS implementation there

Definition

First established a National Tuberculosis Program (NTP) in the 1960's with very poor results. Very few patients finished their treatment as there was a short supply of drugs, support, staff, diagnosis tools and patient follow up. In 1993 RNTCP was established to implemented the WHO DOTS program. The goal was to cure 85% and reach 70%.

They evaluated the intergration of DOTS into different clinics (with controls).

Those with RNTCP were often stuck waiting on lines and just handed drugs to take elsewhere in the clinic. The cure rate was around 70% with a drop out rate between 6-11%

Term

Difficulty of DOTS in India

Definition

More than half of the patients opted out or were excluded from the DOTS program:

the patients either found the logistics too complicated or the provider refused because they did not want those who were less able to comply to their treatment method to spoil their results.

Social marginalization and poverty were key factors in exclusion

Term

Multi-Drug Resistant TB CAUSED BY

(5)

Definition

Erratic drug ingestion

Omission of one or more of the perscribed agents

Suboptimal dosage

poor drug absorption

Insufficient number of active agents in a regimen

Term

Treatment of Mutli-Drug resistant TB

(4)

Definition

18-24 months of treatment

second line drugs which are much harsher than the first course

$200,000 dollars per person

efficacy of treatment is only slightly more than 50% of patients HIV NEGATIVE

Term

MDR TB IN HAITI

Definition

Paul Farmer writes that it is not the individual's fault but rather the structural violence in Haiti that causes their sickness. Structural violence is visited upon ll those whose social status denies them access to the fruits of scientific and social progress.

Term

What predicts compliance to TB treatment?

3 factors

Definition

Free and convinient treatment

access to supplemental food and income

those least likely to comply are those least able to

Term

Lecture 8B - Health and Development

Definition

Term

Definitions of Orphanhood

Definition

Children under the age of 15 who have lost one or both their parents due to any cause

Term

4 types of orphanhood

Definition

Single

Double

Maternal (includes double)

Paternal (includes double)

Term

Why is the definition of orphanhood important?

Definition

It determines how you give out resources and services

NOTE: Human rights groups push for childhood being determined as U 18

Term

What is the conflict between different groups providing different services to the population and how do they differ in how they want to define orphanhood?

Definition

Advocacy groups want big numbers to garner more support but NGO groups providing phsyical services don't or can't necessarily provide for as many numbers.

Term

Social Fostering in Africa

Definition

This was not paid attention to until the AIDS epidemic.

Term

Reality of Social Fostering

Definition

75% not actually orphans

High fertility

high migration

provide labor to families without children

This works as long as money is flowing from children to adults

Caldwell's Theory of Wealth flows

Farming out of kids for labor

Purposive vs. crisis fostering

Crisis fostering is part of Social Immunity

Term

Social Immunity

Definition

Social immunity is the social understanding that, given a crisis, you will take in someone elses children and vice versa. As a result, orphanhood during crisis is much less dire.

Term

What happens to Social Immunity as the AIDS epidemic continues?

Definition

There is a strain on the system. Though the social immunity process absorbed the initial shock from the epidemic, people can no longer take in as many children. There are less adults to take children in since they are dying of AIDS related causes.

Term

AIDS orphans as a percentage of the overall orphan population

Definition

In some places such as Zimbabwe and Zambia and Uganda the percentage of the orphan population representd by HIV /AIDS orphans is as high as 17 and 15 % which means that more of these orphans need to be taken in if the number of orphans is higher.

Term

Epidemic Curves of HIV and AIDS and how this affects orphanhood

Definition

Because there is a delay between initial infection and death from AIDS there is a lag in orphanhood. As a result we can expect a huge jump in AIDS orphans after this delay is caught up.

PREDICT: 25 million orphans

At this time, fostering is no longer as benificial or feasible.

Already there is a jump in the rise of orphanages

Term

Trend in AIDS orphans

Definition

There is an increase in AIDS orphans

Term

Paternal vs. Maternal vs Total orphanhood

Definition

Paternal orphans are plateauing but maternal orphans are rising. Mothernal orphans are the driving force

Term

Double Orphans: AIDS related causes is?

Definition

The number of double orphans is increasing and there is a huge increase of this being attributed to AIDS. Parents are giving each other HIV.

Term

Chances of getting HIV

Definition

1/500 is you have sex once with an infected person

transmission occurrs within 4 months of infection.

Term

Changes in orphanhood:

Used to be because of

________ but now it is because of ______

Definition

Used to be from conflict but now because of AIDS

Term

Number of Orphans in sub-Saharan Africa:

Total

Due to AIDS

Expected to rise to

Double orphans

Definition

There are 48.3 million orphans in Sub-Saharan Africa

12% of children

12 million are from AIDS

Expcted to rise to 25 million to due AIDS when the delay in death occurrs

About 8 millionare double orphans -- a large proportion of this is due to AIDS

Term

Impacts of Orphanhood on Children

(5)

Definition

Parental illness and death

changes in caregiver -- Health: who cares for you matters

changes in caregiver -- Education: impacts your edu

psycho-social impact: don't get enough attention

vulnerability over the lifecourse: impacts you negatively

Term

Parental Illness and death

What is the Double Jeopardy?

Definition

As seen in "HIV and Mortality of Mothers and Children" the double jeopardy is that children whose mother is HIV positive have almost 3 times the risk of death AND children whose mother dies are more than 3 times as likely to die within the next two years of life for both HIV positive and negative mothers. However, since mothers who are HIV positive run a higher risk of death, children of HIV positive mothers run the double risk of having their mother die and that she is HIV positive.

Term

Why is paternal illness and death so bad?

(3)

Definition

Double jeopardy

Parental illness is very harmful and many children die before their parents due to lack of care

Maternal Death increases child mortality threefold

lack of breastfeeding has a huge impact

Term

Changes in Caregivers

Definition

As the AIDS epidemic grows, more and more children are being cared for by their grand-parents because their aunts or uncles cannot take their charge.

Term

Changes in Caregivers: Health

Definition

You are more likely to get your kids vaccinated then foster kids. HOWEVER in 1992, a study shows that foster kids are more likely to be vaccinated. This shows what the impact the HIV/AIDS epidemic has had on foster children in recent years. When the AIDS epidemic first started, it had effected much less people. Children were placed in homes that were better off and often their parents were not dead and still cared for them. In a lot of ways, foster kids were doing a lot better.

Term

Deiniger Study

Definition

Shows the relationship between education and health in foster vs. own children.

Compared in 1992 and 1999

Foster children were pretty much equal if not better than own children in 1992 but there is a drastic shift and in 1999 for health especially foster children are now at a disadvantage when they used to have the advantage

Term

Parental Death and Education

Definition

Low enrollement and investment in educaton is not related to poverty but rather to closeness to the caregiver. The more distantly related to the caregiver, the less likely to be in school.

HAMILTON'S RULE: Closeness of biological ties governs altruism.

Term

Psycho-socio impact

Definition

Children that were orphans demonstrated twice as much anxiety and 2 times as much depression, anger and disruptive behavior.

In addition, children that were orphans were almost 6 times as likely to answer yes to the question: "Do you wish to die?"

Almost 6 times as likely to think that their lives would be bad.

Term

Vulnerability over the life course

Definition

Children who lose their parents do tend to "lose their childhoods" and engage in "risky" adult behavior.

When comparing vulnerable children, the orphans were more likely to experience teen pregnancies, STIs and contract HIV.

Term

Policy Interventions for Children

Conflicts,issues and problems

Definition

40% of countries with HIV epidemics lack policies for orphans

Disagreement on whether or not to target poverty of orphans -- contentious issue. But then also, where do you cut the povert line off?

Household vs institutional care

Emphasize Mother to Child tranmission or Protect Whole Families?

need to protect the whole family because even if the child is not affected with HIV, their health suffers if their parent is sick

Term

Lecture 9A: Women's Education and Child Survival

Definition

Term

Infant Mortality Rate Formula

Definition

# of deaths under 1 year during a specified period

------------------------------------------------------------ x 1000

# of live births occuring during the same time period

Term

Child Mortality Rate Formula (under 5)

Definition

# of deaths U5 years old during a specified time

------------------------------------------------------------ x 1000

# of live births occuring during the same time

Term

Number of Child deaths under 5

in 1999

in 2008

Where do they occur?

Definition

1999: 10.4 million

2008 : 8.8 million

98% occur in developing countries

Solutions are cheap and could be made widely available!

Term

Mortality by age group and development level : What do you see?

Definition

See that in the developing world, there is a very steap and extreme number of deaths in the 0-4 years of age range, on top of the gradual increase in deaths as you move up the age grade. However, there are more deaths than in the developing world.

Term

Distribution of Child Deaths

Definition

Africa contains 10 % of the population but account for 1/2 the child deaths

Asia is 40% of the population and represents another large portion of child deaths

.1% of child deaths from the developed countries

West and Central Africa and South Asia are the areas with the highest proportion of child deaths (UNICEF)

Term

Why is there a shift in the rate of decline in child mortality?

Definition

End of the Cold War

SAPs -- the article blames most of it on this

AIDS

Plateauing

There is a steap decline in child mortality until about 1990 after which the decline is much less steep.

Term

MDG 4: Reduce the number of childhood deaths under 5 by 2/3 by 2015

What does it look like?

Definition

Sub-Saharan Africa does not look like it will at all despite the fact that it would be very cheap to make drastic changes to the mortality rate there. It woud also be a lot easier.

Term

Progress towards MDG 4

Definition

South Asia and Africa no progress or not on track

Term

Major causes of infant mortality

(6)

Definition

Acute respiratory infection (ARI) (Pneumonia)

Diarrhea

Measles

Malaria

Perinatal (usually kills wihtin the first month)

Other (accidents, congenital disorders etc...)

YET

Pneumonia would be easy to treat with antibiotics

Diarrhea is really easy to treat with clean water and salts and fluids -- misconception that you should stop giving children fluids so they die of dehydration.

Term

Malnutrition plays a MAJOR role in 50% of these deaths

Make these diseases deathly when the child is malnourished

Definition

Term

Women's Education and Mortality

What does one year of education for the mother correspond to in terms of decline in under 5's mortality

Definition

7-9% decline in U5 mortality with every year of additional maternal education

Term

Education between men and women

Definition

EDU for men and women has increased and evened out. The number of years between men and women is about the same. In many places women are getting MORE education then men.

Term

Impact of maternal education between 1970 and 2009

Definition

More than half of the reduced number of deaths attributed to maternal education in a study that compared all the factors leading to the decrease.

Term

GDP versus Maternal Education

Definition

Can see that if GDP had remained at the 1970 levels, child mortality would only be very slghtly higher whereas if the maternal EDU levels were where they were in the 1970's, the child mortality rate would have been very much higher.

With both GDP and maternal EDU at levels from the 1970, mortality would have been at its highest.

Term

Relationship between Poverty and mother's edu and CHild mortality

Definition

See that child mortality decreases steadily along the wealth gradient. Being in the richest versus the poorest gradient cuts mortality in half

Yet, the difference between women that had recieved only primary edu or none at all and women who had recieved secondary or higher education had also halved the number of child mortality rates.

Wealth and education are obviously correlated -- wealthy tend to have more education.

Term

Effect of maternal education between the years of 3-5

Definition

Cuts the chance of death by half

** neonatal issues are beyond a mother's control but later on in life, a mother can impact her children's health**

Term

Correlates and Predictors of Infant and Child Mortality

(10)

Definition

Low birth weight

maternal age (over 40 and under 20 is more dangerous)

birth interval

Birth order and plurality (twins or triplets less healthy)

sex

breastfeeding

maternal education

Ethnicity and culture

Economic and environmental conditions including health care

maternal health including HIV

Term

Need conceptual framework to understand all the factors

MOSELY - CHEN ANALYTIC FRAMEWORK

Aims:

(3)

Definition

What predicts when a child gets sick?

Combines both mortality and growth faltering/stunting

Uses a gradient of malnutrition with death being the highest grade

Term

Proximate determinants of the Mosely - Chen analytic framework

(5)

Definition

Maternal Factors

Environmental Contaminents

Injury

Nutrient Deficiency

Personal Illness control (treatment and prevention)

Term

The five proximate determinants of the Mosely - Chan analytic framework are determined by socio-economic factors. These socio-economic factors are broken into 3 different parts:

Definition

Individual variables (edu, productivity, norms, beliefs, traditions)

household variables (income/wealth)

community variables (ecological, political, econ, health system)

Term

Two most important socioeconomic determinants that effect all the proximate determinants

selectivity of mothers (rural, less educated women tend to be in polygamous relationships)

Over crowding

Rivalry among co-wives

In polygamous societies, there are lower HIV rates but having concurrent partnership raises the risks of infection

Problem when there are urban and rural wives and they don't get the benifits of polygamy

Term

Overall effect of Polygamy on children

Definition

Negative

Children have higher risks of dying when born into a polygamous family

Term

GRAPH: Effects of Polygyny over Child's age

Definition

First year of life there is no difference between monogomous and polygamous

Between 2 and 5 the risks are higher for polygynous kids because the social factors start to take effect

Term

two ways for women to become single mothers

Definition

pre-marital birth

divorce/widowhood before child turns 15

Term

What are the effects of single motherhod on child mortality?

Definition

dying before the age of 5 with a single mother increases between 33-66 %

YET EDUCATION: no edu increases the probability of childmortality between 0 and 84%

Term

Possibility of becoming a single mother

Definition

betwen 30-70% of women can expect to become single moms before their 45th birthday if current trends continue

Term

10B: Maternal Mortality

Definition

Term

Maternal death

Definition

The death of a woman when she is pregnant or within 42 days of the end of the pregnancy, irrespective of the duration and site of the pregnancy from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes

Term

Late Maternal Death

Definition

Death of a womanfrom direct and indirect obstetric causes more than 42 days after but less than one year after the termination of a pregnancy

Term

Pregnancy related death

Definition

Death of a women while pregnant or within 42 days of the termination of pregnancy, irrespective of the cause of death

Term

Direct obstetric deaths

Definition

death relating to obstetric complcations of the pregnant state (pregnancy, labor and postpartum) resulting from either of the three

Term

Indirect Obstetric deaths

Definition

Deaths resulting from previous existing disease or disease that developed during pregnancy and which was not due to direct obstetric causes but was aggravatd b physiologic effects of pregnancy

Term

maternal mortality ratio

Definition

# of deaths to women from pregnancy-related cases

----------------------------------------------------------------

# of live births

expressed as a number over 100,000 live births

Term

maternal mortality rate

Definition

# of deaths to women from pregnancy during a specific period

-----------------------------------------------------------------

# of women of reproductive age during specific time

Term

Indirect Sisterhood Method

Definition

Ask people about their adult sisters

- can use small sample size

- ask four questions

- good for high fertility settings

- long term retrospective period

ask :

how many total numer of sisters did you have who reached the age of 15?

How many are still alive?

How many dead?

How many of these sisters died during childbirth, right after childbirth or while pregnant?